scholarly journals 662 PAP Therapy: A Review of Resources for the Uninsured during COVID-19

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A259-A259
Author(s):  
Melissa Malinky ◽  
Abigail Oberla ◽  
Meena Khan ◽  
M Melanie Lyons
Keyword(s):  
Low Income ◽  
Web Search ◽  
Low Cost ◽  
Wait Time ◽  
The United States ◽  
Fixed Cost ◽  
United States Census ◽  
Lower Socioeconomic ◽  
Increased Risk ◽  
Available Resources

Abstract Introduction In 2019, the United States Census estimated 8% (26.1 million) people were without health insurance. Further, an estimated 3.5 million people became/remained uninsured from COVID-19-related job losses. Patients with OSA that belong to a lower socioeconomic status (SES) are less likely to have access to healthcare and may be under or uninsured. Untreated OSA can lead to increased risk of symptoms and associated co-morbidities. Resources to help the uninsured to obtain PAP therapy were available pre-COVID, including two main sources, American Sleep Apnea Association (ASAA) and our local branch serving central Ohio, The Breathing Association. However, the COVID pandemic limited access or closed these programs. Our Sleep Medicine clinics saw 148 uninsured OSA patients between March-December, 2020. Given these difficulties, we re-evaluated available resources for the uninsured. Methods We conducted a search for current low cost ($100 or less) PAP therapy options for the uninsured, March 15, 2020-December 3, 2020, by: (1) contacting pre-COVID-19 resources, including Durable Medical Equipment (DME) providers, (2) consulting social work, and (3) completing a librarian assisted web-search not limited to PubMed, Embase, CINAHL for academic related articles and electronic searches using a combination of English complete word and common keywords: OSA, PAP, uninsured, no insurance, cheap, medically uninsured, resources, self-pay, low-income, financial assistance, US. Resources such as private sellers were not investigated. Results During COVID-19, assistance for PAP machines/supplies have closed or required a protracted wait-time. Options including refurbished items range from low, one-time fixed cost or income-based discounts from: one local charity (Joint Organization for Inner-City Needs) and DME (Dasco), and four national entities (ASAA, Second Wind CPAP, Reggie White Foundation, CPAP Liquidators). An Electronic Health Record-based tool was developed and distributed to increase provider awareness of pandemic available resources. Conclusion Untreated OSA is associated with increased risk of cardiovascular co-morbidities. Access and cost may limit treatment in OSA patients from a lower SES. The COVID-19 pandemic has shuttered programs providing discount PAP and supplies, leaving fewer resources for these patients, thus further widening this health care disparity. Alternatives are needed and current resources are not easily accessible for providers and patients. Support (if any):

Abstract 17385: CPR Education in High-need Schools to Increase Student Knowledge and Comfort Performing CPR

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Debra Heard ◽  
Comilla Sasson
Keyword(s):  
Low Income ◽  
Classroom Teacher ◽  
Low Cost ◽  
The United States ◽  
Training Data ◽  
Paired Data ◽  
School Students ◽  
Chi Square ◽  
Bystander Cpr ◽  
Cpr Training

Introduction: Low-income neighborhoods are important targets for CPR trainings as they typically have high incidence of out-of-hospital cardiac arrest and low prevalence of bystander CPR. Training middle school students in these neighborhoods is a novel intervention to increase CPR awareness. Objective: Conduct a school-based CPR intervention using classroom teachers as facilitators at 1131 middle schools across the United States with a high proportion of students from lower-income families. Methods: Population: 1131 public middle and high schools in 34 states (including the District of Columbia) were selected for the 2014-2015 school year to participate based on close proximity to sponsor’s U.S. store locations and 50% or more student eligibility for free or reduced-price lunch. Intervention: Participants completed a pre-test survey to assess baseline knowledge of CPR and comfort performing CPR. A classroom Hands-Only CPR training lasting one class period was conducted with the CPR in Schools Training Kit™, which includes an educational DVD, 10 manikins and resources for any classroom teacher to conduct trainings. Participants then completed post-training knowledge and comfort survey. McNemar’s tests on paired data and chi square and t-tests on aggregated unpaired data were conducted to assess for differences in CPR knowledge and comfort performing CPR pre- and post-training. Results: Training data were returned by 563 (49.8%) participating schools training a total of 150,409 students in Hands-Only CPR. Using a sample of returned data, the mean number of questions answered correctly on CPR knowledge increased from 2.5 to 4.2 (out of 5). The majority of participants (75.8%) felt comfortable performing Hands-Only CPR after the intervention. Conclusion: A total of 150,409 students from 563 schools were trained in Hands-Only CPR (average 267 students/CPR in Schools Training Kit). At $625 per CPR in Schools Training Kit (with 10 manikins and materials), training cost $4.70 for each student trained. Participants demonstrated increased knowledge of and comfort performing CPR. The CPR in Schools Training Kit is a low cost and promising method for increasing bystander CPR awareness in the student population in low-income neighborhoods.

Food Choice With Economic Scarcity and Time Abundance: A Qualitative Study

2021 ◽  
pp. 109019812110459
Author(s):  
Sara C. Folta ◽  
Oyedolapo Anyanwu ◽  
Jennifer Pustz ◽  
Jennifer Oslund ◽  
Laura Paige Penkert ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Low Income ◽  
Food Choice ◽  
Resource Constraints ◽  
Low Cost ◽  
The United States ◽  
Photo Elicitation ◽  
Semistructured Interview ◽  
Relative Time ◽  
Multiple Resource

Consumers with low income in the United States have higher vulnerability to unhealthy diets compared with the general population. Although some literature speculates that scarcity is an explanation for this disparity, empirical evidence is lacking. We conducted a qualitative study of food choice to explore whether scarcity-related phenomena, such as tunneling and bandwidth tax, may contribute to unhealthy dietary choices. We used participant-driven photo elicitation ( n = 18) to investigate the food choice behaviors of individuals living in the greater Boston area who met the federal guidelines for poverty. Participants took photos at the point of food acquisition for 1 month, after which we interviewed them using a semistructured interview guide with the photos as prompts. Thematic coding was used for analysis. Respondents had relative time abundance. Two major themes emerged: participants used a set of strategies to stretch their budgets, and they highly prioritized cost and preference when making food choices. The extreme focus on obtaining food at low cost, which required time and effort, was suggestive of tunneling. We found no evidence of the bandwidth tax. Our findings raise the hypothesis of scarcity as a continuum: when individuals experience multiple resource constraints, they experience scarcity; whereas people with very limited finances and relative time abundance may instead be in a prescarcity condition, with a hyperfocus on a scarce resource that could lead to tunneling as constraints increase. Additional studies are needed to understand whether and how tunneling and bandwidth tax emerge, independently or together, as people face different levels and types of scarcity.

scholarly journals Polydrug Use During Pregnancy and Preterm Birth in a Low-Income, Multiethnic Birth Cohort, Boston, 1998-2018

2020 ◽  
Vol 135 (3) ◽  
pp. 383-392
Author(s):  
Henri M. Garrison-Desany ◽  
Nobutoshi Nawa ◽  
Yoona Kim ◽  
Yuelong Ji ◽  
Hsing-Yuan (Susan) Chang ◽  
...  
Keyword(s):  
United States ◽  
Preterm Birth ◽  
Birth Cohort ◽  
Preterm Delivery ◽  
Low Income ◽  
The United States ◽  
Reproductive Age ◽  
Polydrug Use ◽  
Stimulant Drugs ◽  
Increased Risk

Objective The opioid epidemic in the United States increasingly affects women of reproductive age and has resulted in a rise in concurrent polydrug use. The objective of this study was to investigate the effect of this polydrug use on preterm birth in a multiethnic birth cohort. Methods We analyzed data from 8261 mothers enrolled in the Boston Birth Cohort from 1998 to 2018 in Boston, Massachusetts. We grouped substances used during pregnancy based on their primary effects (stimulant or depressant) and assessed independent and combined associations with smoking on preterm birth. Results Of 8261 mothers, 131 used stimulant drugs and 193 used depressant drugs during pregnancy. The preterm birth rate was 27.5% (2271 of 8261) in the sample. Mothers who smoked had 35% increased odds of preterm birth across adjusted models. Mothers who used stimulant drugs without smoking were not at increased risk of preterm delivery compared with mothers who used neither (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.19-1.98), whereas mothers who used depressant drugs without smoking had more than twice the odds of having preterm delivery (OR = 2.31; 95% CI, 1.19-4.44), and infants were at risk of a 1-week reduction in gestational age (OR = −1.05; 95% CI, −2.07 to −0.03). Concurrently smoking and using depressant drugs was associated with increased odds of preterm birth (OR = 1.83; 95% CI, 1.28-2.61), as was concurrently smoking and using stimulant drugs (OR = 1.73; 95% CI, 1.14-2.59). Conclusions Using stimulant drugs and depressant drugs during pregnancy is a risk factor for preterm birth. The individual and combined effects of using these drugs with smoking must be considered together to reduce the risk of preterm birth in the United States.

Is Cost of Living Related to Living Alone Among Older Persons? Evidence From the Elder Economic Security Standard Index

2015 ◽  
Vol 38 (17) ◽  
pp. 2495-2511
Author(s):  
Jan E. Mutchler ◽  
Jiyoung Lyu ◽  
Ping Xu ◽  
Jeffrey A. Burr
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Metropolitan Areas ◽  
Low Cost ◽  
The United States ◽  
Economic Security ◽  
Living Alone ◽  
Cost Of Living ◽  
Standard Index ◽  
Security Standard

This study examines whether the cost of living is related to the probability of living alone among unmarried persons age 65 years and older in the United States. Cost of living is measured at the metropolitan area level by the Elder Economic Security Standard Index, which takes into account geographic variability in cost of housing, food, transportation, and medical care. Using multilevel modeling, we find that higher cost of living is related to a lower likelihood of living alone net of personal resources. Results also show that the gap in the likelihood of living alone between high- and low-income older adults is slightly lessened in low-cost metropolitan areas. We conclude that the price of “purchasing privacy” is substantially higher in some metropolitan areas than in others. These findings inform policies designed to help older adults age in place.

scholarly journals Differences in COVID-19 Testing and Test Positivity Among Veterans, United States, 2020

2021 ◽  
pp. 003335492110094
Author(s):  
Jacqueline M. Ferguson ◽  
Hoda S. Abdel Magid ◽  
Amanda L. Purnell ◽  
Mathew V. Kiang ◽  
Thomas F. Osborne
Keyword(s):  
United States ◽  
African American ◽  
Low Income ◽  
The United States ◽  
Positive Test ◽  
Health Administration ◽  
Positive Test Result ◽  
Black African ◽  
Increased Risk ◽  
Test Result

Objective COVID-19 disproportionately affects racial/ethnic minority groups in the United States. We evaluated characteristics associated with obtaining a COVID-19 test from the Veterans Health Administration (VHA) and receiving a positive test result for COVID-19. Methods We conducted a retrospective cohort analysis of 6 292 800 veterans in VHA care at 130 VHA medical facilities. We assessed the number of tests for SARS-CoV-2 administered by the VHA (n = 822 934) and the number of positive test results (n = 82 094) from February 8 through December 28, 2020. We evaluated associations of COVID-19 testing and test positivity with demographic characteristics of veterans, adjusting for facility characteristics, comorbidities, and county-level area-based socioeconomic measures using nested generalized linear models. Results In fully adjusted models, veterans who were female, Black/African American, Hispanic/Latino, urban, and low income and had a disability had an increased likelihood of obtaining a COVID-19 test, and veterans who were Asian had a decreased likelihood of obtaining a COVID-19 test. Compared with veterans who were White, veterans who were Black/African American (risk ratio [RR] = 1.23; 95% CI, 1.19-1.27) and Native Hawaiian/Other Pacific Islander (RR = 1.13; 95% CI, 1.05-1.21) had an increased likelihood of receiving a positive test result. Hispanic/Latino veterans had a 43% higher likelihood of receiving a positive test result than non-Hispanic/Latino veterans did. Conclusions Although veterans have access to subsidized health care at the VHA, the increased risk of receiving a positive test result for COVID-19 among Black and Hispanic/Latino veterans, despite receiving more tests than White and non-Hispanic/Latino veterans, suggests that other factors (eg, social inequities) are driving disparities in COVID-19 prevalence.

scholarly journals A Home Hazard Removal Program to Reduce Falls in Community-Dwelling Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 385-385
Author(s):  
Susy Stark
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Fall Risk ◽  
Low Cost ◽  
Management Program ◽  
Community Dwelling ◽  
Control Group ◽  
Age In Place ◽  
Increased Risk ◽  
Community Dwelling Older Adults

Abstract The majority of falls experienced by older adults occur in the home with home hazards associated with an increased risk of falling. Low-income older adults, who have more disability and live in substandard housing, need feasible interventions to help them safely age in place. The Home Hazard Removal Program (HARP) is a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists to prevent falls. To evaluate the program, a randomized control trial was conducted with 310 community-dwelling older adults receiving aging services in the community. HARP had high acceptability with older adults and was feasible to deliver in the community. Adjusted for fall risk, individuals in the HARP group fell 1.4 times versus 2.2 times in the control group over 12 months. This low-cost home hazard removal program demonstrated acceptability, feasibility, and a significant reduction in falls for at-risk community-dwelling older adults.

Immigrant Small Business and International Economic Linkage: A Case of the Korean Wig Business in Los Angeles, 1968–1977

1996 ◽  
Vol 30 (2) ◽  
pp. 485-510 ◽  
Author(s):  
Ku-Sup Chin ◽  
In-Jin Yoon ◽  
David Smith
Keyword(s):  
United States ◽  
Los Angeles ◽  
South Korea ◽  
Low Income ◽  
Low Cost ◽  
Economic Restructuring ◽  
The United States ◽  
Korean Immigrants ◽  
Asian Immigrants ◽  
Economic Linkages

This article investigates factors that have contributed to the growth of the import-export business among Asian immigrants. The central argument is that the development of Asian immigrants’ import-export business has been closely related to the increasing economic linkages between Asian countries and their countrymen in the United States. Such economic linkages are a product of the global economic restructuring whereby some developing countries of Asia have become major exporters of low cost/low price consumer goods to the United States. The Korean immigrants’ wig business in Los Angeles is studied as a case of contemporary import-export trade among Asian immigrants, with major findings summarized as follows: first, the increased reliance of the United States on imported goods by the 1970s led to a rapid growth of the export-oriented industry in South Korea; second, wigs became the major export item of South Korea due to its cheap labor force and government-aid loans to the wig industry, third, a strong vertical integration developed between Korean wig manufacturers in South Korea and Korean importers, wholesalers, and retailers in the United States – that integration provided Korean immigrants with initial business opportunities in the U.S. economy, particularly in the low-income minority areas.

scholarly journals Asthma Risk Associated with Indoor Mold Contamination in Hispanic Communities in Eastern Coachella Valley, California

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Ryan Sinclair ◽  
Charity Russell ◽  
Genevieve Kray ◽  
Stephen Vesper
Keyword(s):  
United States ◽  
Low Income ◽  
House Dust ◽  
Respiratory Illness ◽  
The United States ◽  
Coachella Valley ◽  
Asthma Risk ◽  
Increased Risk ◽  
The Us ◽  
Indoor Mold

Indoor mold contamination has been associated in many studies with an increased risk of asthma and respiratory illness. This study investigated indoor mold contamination and the prevalence of asthma/respiratory illness in two low-income, Hispanic communities, Mecca and Coachella City, in the Eastern Coachella Valley (ECV) of California. The study consisted of a questionnaire to assess asthma/respiratory illness and the quantification of mold contamination in house dust samples using the Environmental Relative Moldiness Index (ERMI) scale. About 11% of the adults and 17% of the children in both Mecca and Coachella City met our definitions of asthma/respiratory illness. The average ERMI values in Mecca and Coachella City housing (10.3 and 6.0, respectively) are in the top 25% of ERMI values for the United States (US) homes. Overall, the homes surveyed in these ECV communities had an average prevalence of occupant asthma of 12.8% and an average ERMI value of 9.0. The prevalence of asthma/respiratory illness in the Hispanic communities of Mecca and Coachella City and the mold contamination in their homes appear to be greater than the averages for the rest of the US. The higher levels of mold contamination in their homes appear to be associated with a greater risk of asthma/respiratory illness for these low-income, Hispanic communities.

A nationwide analysis of inpatient outcomes and healthcare utilization in HIV versus non-HIV patients with esophageal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16106-e16106
Author(s):  
Syed Ali Amir Sherazi ◽  
Ikechukwu Achebe ◽  
Jennifer C Asotibe ◽  
Bibek Singh Pannu ◽  
Bashar Attar ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Healthcare Utilization ◽  
Low Income ◽  
Protein Energy Malnutrition ◽  
Survival Rates ◽  
Kidney Injury ◽  
The United States ◽  
Hospital Charges ◽  
North East ◽  
Increased Risk

e16106 Background: Esophageal cancer (EC) is an aggressive malignancy with poor 5-year survival rates (19.9%). Due to effective Antiretroviral Therapy, mortality from HIV/AIDS has precipitously decreased leading to longer lifespan and increased risk of developing non-AIDS defining cancers. There is paucity of data regarding outcomes of Esophageal Cancers in patients with HIV (HIV-EC). We undertook this analysis to study the outcomes of HIV-EC with healthcare utilization compared to non-HIV-EC patients. Methods: The Healthcare Cost Utilization Project (HCUP) Nationwide Inpatient Sample was queried to identify patients with HIV and non-HIV-EC using ICD-10 codes. Groups were compared for demographic differences, inpatient mortality, length of stay (LOS) and hospital charges. Secondary outcomes studied included rates of septic shock (SS), Esophageal Obstruction (EO), Anemia, Pneumonia, Tracheoesophageal Fistula (TEF), Upper GI Bleed (UGIB), Acute Kidney Injury (AKI), protein energy malnutrition (PEM). Statistics were performed using the t-test, chi-square test and logistic regression. Results: A total of 330 inpatient admissions with HIV-EC and 117505 with non-HIV-EC were identified. Patients with HIV-EC were significantly younger (mean age 58.5 vs 66.9 years, p < 0.001) with 83% under 65 years of age compared to 41% in non-HIV-EC group (p < 0.001). Higher number of HIV-EC patients were African American (AA) (51.5% vs 10%, p < 0.001) with similar gender ratio (19.7% vs 21.3% women), belonged to lowest income quartile zip codes (42% vs 27%, p = 0.01), more likely to be on Medicaid (36% vs 11%, p < 0.001) and hailed from North East (NE) or Southern regions of the US (79% vs 56%, p = 0.003). The overall mortality rate was significantly higher in the HIV-EC group than non-HIV-EC (13.6% vs 8.8%, p = 0.001). The mean inpatient LOS (7.4 vs 6.98 days) and total hospital charges ($65,358 vs $80,620) were not significantly different between the two groups. Rates of PEM were higher in HIV-EC (61% vs 44%, p < 0.01) but rates of sepsis, SS, UGIB, EO, TEF, Anemia, TLS, AKI were not significantly different than non-HIV-EC. There was no difference in rates of specific medical co-morbidities between groups, although HIV-EC had a significantly higher Charlson Comorbidity Index (p < 0.001). Conclusions: Despite being significantly younger, HIV-EC patients have significantly higher mortality compared to non-HIV-EC. However, the inpatient LOS and total charges were not significantly different. HIV-EC were more likely to be AA on Medicaid and from low-income zip codes from the NE or South of the United States. Further studies are needed to study the role of early diagnosis, perhaps screening in younger patients with HIV to prevent mortality.

Using Ethnography to Assess Barriers to Services in a Washington DC Community Clinic

2005 ◽  
Vol 27 (2) ◽  
pp. 5-9
Author(s):  
Michelle Goodman
Keyword(s):  
Health Care ◽  
Low Income ◽  
Health Care Services ◽  
Low Cost ◽  
Strong Predictor ◽  
The United States ◽  
Washington Dc ◽  
Kaiser Family Foundation ◽  
Community Clinic ◽  
Care Services

There are over 42 million uninsured people living in the United States today. Even though a small percent of these 42 million are immigrants, they are more likely to be uninsured because of limited access to low-cost insurance. This is particularly true for those who are low-income, unemployed or under-employed (Kaiser Family Foundation, April 2001). Low-income immigrants may face a number of barriers to accessing health care services, which, in turn, can cause disparity in health outcomes compared to individuals who have health insurance. Latinos represent about 12% of the population, but make up 25% of the Nation's uninsured (American College of Physicians 2000). Newly immigrant Latinos are almost three times less likely to have a consistent source of medical care, which is a strong predictor of obtaining preventative health care screening (American College of Physicians 2000). Since each community experiences the health care system in different ways and because political, economic and social conditions influence the availability and accessibility of services, it is important to identify these barriers for each individual community cohort that a community clinic and/or program may be working with.

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